A Comparative Study of Voiding and Sexual Function after Total Mesorectal Excision with Autonomic Nerve Preservation for Rectal Cancer: Laparoscopic Versus Robotic Surgery
A Comparative Study of Voiding and Sexual Function after Total Mesorectal Excision with Autonomic Nerve Preservation for Rectal Cancer: Laparoscopic Versus Robotic Surgery
复制标题
DOI：
10.1245/s10434-012-2262-1
复制
发表时间：
2012-08-01
影响因子：
3.7
通讯作者：
Kim, Jang Hwan
中科院分区：
文献类型：
--
作者：
Kim, Jeong Yeon;Kim, Nam-Kyu;Kim, Jang Hwan
为了评价机器人辅助直肠癌全直肠系膜切除术（R-TME）与腹腔镜全直肠系膜切除术（L-TME）相比对泌尿生殖系统功能的保护作用。前瞻性纳入69例接受L-TME（n = 39）或R-TME（n = 30）的患者。在术前和术后1、3、6和12个月，通过尿流率测定、国际前列腺症状评分（IPSS）标准问卷和国际勃起功能指数（IIEF）评估其泌尿生殖功能。通过配对t检验比较各组术前和术后IPSS和IIEF评分，以检测功能恶化。比较两组患者术后IPSS、IIEF评分及尿流率数据偏离术前值的情况（Delta），术后1个月IPSS评分明显升高，L-TME组患者6个月后尿功能下降恢复（8.2 +/- A 6.3; P = 0.908），而R-TME组为3个月（8.36 +/- A 5.5; P = 0.075）。3个月时两组Delta IPSS评分差异有统计学意义（P = 0.036）。在男性患者中（L-TME 20，R-TME 18），R-TME和L-TME的IIEF总分在术后1个月显著降低，L-TME在12个月内逐渐恢复（46.00 +/- A 16.9; P = 0.269），但R-TME在6个月内恢复（44.61 +/- A 13.76; P = 0.067）。Delta IIEF评分值在两组之间在任何时间都没有显著差异，但在勃起功能和性欲变化的逐项分析中，两组在3个月时有显著差异。与接受L-TME的患者相比，直肠癌的R-TME与正常排尿和性功能的早期恢复相关，尽管这一结果需要通过更大规模的前瞻性比较研究来验证。
To evaluate the protection of the urogenital function after robot-assisted total mesorectal excision (R-TME) for rectal cancer compared to those of laparoscopic TME (L-TME).69 patients who underwent L-TME (n = 39) or R-TME (n = 30) were prospectively enrolled. Their urogenital function was evaluated by uroflowmetry, a standard questionnaire of the international prostate symptom score (IPSS) and the international index of erectile function (IIEF) before surgery and 1, 3, 6, and 12 months after surgery. The pre- and postoperative IPSS and IIEF scores were compared to detect functional deterioration by paired t test for each group. How postoperative IPSS and IIEF scores and uroflowmetry data deviated from the preoperative values (Delta) were statistically compared between the two groups.The IPSS score significantly increased 1 month after surgery; the recovery from decreased urinary function took 6 months for patients in the L-TME group (8.2 +/- A 6.3; P = 0.908) but 3 months in the R-TME group (8.36 +/- A 5.5; P = 0.075). The Delta IPSS scores were significantly different between the two groups at 3 months (P = 0.036). In male patients (L-TME 20, R-TME 18), the total IIEF score in R-TME and L-TME significantly decreased 1 month after surgery, L-TME gradually recovered over 12 months (46.00 +/- A 16.9; P = 0.269), but R-TME recovered within 6 months (44.61 +/- A 13.76; P = 0.067). The Delta IIEF score value was not significantly different at any time between the two groups, but in an itemized analysis of the change in erectile function and sexual desire, there were significant differences at 3 months between the two groups.R-TME for rectal cancer is associated with earlier recovery of normal voiding and sexual function compared to patients who underwent L-TME, although this result needs to be verified by larger prospective comparative studies.